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retroworks writes "The NHS and the Daily Telegraph report on two studies (original and repeat duplicating results) in Estonia and Finland which predict whether an apparently healthy human will likely diewithin 5 years. The four biomarkers that appeared to determine risk of mortality in the next five years were: alpha-1-acid glycoprotein – a protein that is raised during infection and inflammation; albumin – a protein that carries vital nutrients, hormones and proteins in the bloodstream; very-low-density lipoprotein (VLDL) particle size – usually known for being 'very bad' cholesterol; and citrate – a compound that is an essential part of the body's metabolism. Researchers found that people in the top 20% of the summary score range were 19 times more at risk of dying in the next five years than people in the lowest 20%."
The NHS's summary of the news points out that "the implications of such a test are unclear. As this was an observational study, it can only show an association between the biomarkers and risk of death. It does not predict what the underlying cause of death would be for an individual and does not therefore provide an answer in terms of treatment."

That's not compassionate, that's just stupid. No way we should be "insuring" people who are going to die within 5 years. Or at least not calling it "insurance", since it's not ensuring the person won't die. Call it end-of-life welfare, or terminal socialism, or something more accurate like that. My suspicion is it will make the Death Panels that the Republicans complained about a stark reality.

Also, can you imagine the havoc this could wreak with people trying to go out with a bang and spending their life savings and settling old scores before they kick it? And the lawsuits that could be flying around after people spend all their money after false positives?

What is wrong with death panels? Seriously. Aside from the name. When medical science advances so that with enough money we could keep someone alive indefinitely. Then the question is, is it worth it?
Years ago, and mostly today, this question didn't exist, because we didn't have technology and know how to do it. But eventually we will, and it will be a hard question.
Also, I agree about the name- It is "health care" not "health insurance". I just don't get hung up on it.

I'll ignore the snark about Obama, but - trust me on this, white man - once you've watched a loved one like, say, your mother going through years and years of pain, confusion, terror and misery from Alzheimer's because there IS NO OTHER OPTION LEGALLY ALLOWED, you just might change your alleged mind on the subject.
Have a nice day and I hope you never have to confront reality.

On the other hand, think of all the fucked up shit people live through - people who could have killed themselves, but don't - and ask yourself if you're absolutely certain she'd want to die. I had a close relative with Alzheimer, in the end she didn't even recognize her own children. She was of course confused and scared, but I don't know - she never seemed to be in the kind of pain and misery you'd need to be suicidal, I think she lost that level of introspection and more or less drifted off into her own w

When medical science advances so that with enough money we could keep someone alive indefinitely. Then the question is, is it worth it?

Probably.

Most medicines are cheap to manufacture; it's the initial research that costs money, which gets passed on to consumers through patents. Machines cost some, but are getting cheaper and better as technology marches on. That leaves doctor time as the main cost, but advancing automation should eliminate most of checkups.

There is a lot of a handwaving in your post. I encourage you to do some more reasearch on just how much medical costs are.

Before you say the medicines are cheap to manufacture, I think you should look into how we don't have enough anti-biotics, and that outsourcing our drug manufacturing to china/india to make it cheaper is killing people (see haparin).

I don't recall the ACA having any provisions related to life insurance. Sure you can keep your health insurance, but the life insurance company will cancel your policy, leaving your family unprotected when treatment fails and you die.

"Next" policy update? This year my company-provided insurance demanded full physicals for me and my wife (not the kids) including 3 vials of blood. That goes for EVERYONE in the company (~3000 in our branch, millions world-wide).

That said, we are insured in spite of the fact that my (very blunt) doctors told me I would likely never leave the hospital. And, if I did, I wouldn't live more than 4 months without a $300k transplant - And it would take 6 months just to get me on the waiting list. That was a year ago last November and at this point they're saying a transplant would be unnecessarily dangerous compared to its benefits. Suffice it to say, the test results may have been accurate and properly interpreted, but the predictions indicated didn't play out as planned.

It's more likely, they would deny you new coverage if your markers were up but that once you signed up - if you paid your premiums, then you would continue to be covered without further tests. And of course for term life, it wouldn't come up at all after you bought the policy.

Our insurance plays the 'New Speak' game. They don't 'charge you more' when they don't like the results of your mandated yearly physical. They just 'don't offer you the discounts' that they offer to people who's test results they do like.

While you can certainly make poor lifestyle choices that increase your risk, you can also make all the 'correct' choices, cut yourself while doing your healthy outdoor activities on something stupid, get flesh eating bacteria, and die.

They are not saying "these activities" are high risk, but "these compounds that everyone has and fluctuate for a variety of reasons not all controlled by the individual" indicate risk. It's like saying something like "white people have a higher risk of this fatal disease (let's say... skin cancer) so lets drop all white people and tell them well, you should have known better than to be white".

i see the older generation from my birth country eating all kinds of crap i rarely touch and they are all on all kinds of prescription drugs to control high blood pressure and lots of other problems. meanwhile my wife and i take care of ourselves and people think we look 10 years younger

True. Even if you already have heath issues and are over 55yo, improving one's lifestyle can make a dramatic difference. Simply eating less in a culture where everybody overeats all the time and thinks that's "normal" will make a big difference. Just eating less simple carbohydrates and having some vague awareness of calorie intake shaved a full 30kgs off my weight! I know that getting back into hard exercise, though it will kill me to start that up again, will shave 20 years off my physiological age a

Food, is both piratical in giving you energy to live, and emotional as it give you joy to eat something in particular.

Now your body has a craving system in it. When things are good it means you want food to fill a particular nutrient imbalance in your system.However if you grow up being fed junk food, this craving system gets out of whack. Where it says I need some protein it would say I want a doughnut, because while growing up on junk foo

I have found that looking younger tends to be less about Diet, Drugs, Smoking and Alcohol usage. I find that it has more to do with stress. The reason that it looks like people to do a lot of drugs, smoke and drink a lot age faster is because there is a huge correlation between the said activities and high stress lifestyles.

Your sample set of 2 is certainly proof positive that your lifestyle will work for all 8 billion people living on this planet and anyone who is sick must have just been taking stupid risks.

The arrogance of people who believe that they know best is truly astounding. Unless you are a doctor and specifically MY doctor you have no right to judge my lifestyle. As a point of fact, my doctor specifically told me once that anything I could eat (didn't matter what, ice cream, pizza, whatever as long as it was food

i see the older generation from my birth country eating all kinds of crap i rarely touch and they are all on all kinds of prescription drugs to control high blood pressure and lots of other problems. meanwhile my wife and i take care of ourselves and people think we look 10 years younger

It's not like changing ones lifestyle happens magically either. Point being that if it took time to develop it will proably take even more time to correct and by the time these markers can even be found, it may already be too late.

That, plus what evidence is there that these markers are directly influenced by lifestyle?

Smoking? Choice. Drinking? Choice. Eating crappy foods? Mostly choice. Genetics? You're pretty much stuck with what you have. Unless you're proposing some 'final solution', some people just have it rough.

Without risk there wouldn't BE an insurance industry. Suppose there was a test which could determine exactly all of your future medical care costs and when you were going to die. There would be no financial risk at all. Health insurance would become, essentially, a savings plan. There'd be no profit any more.

This is also why a pure insurance model is always likely to be unacceptable in places like the UK. People here - and, I would guess, in most of the world - don't want just a way to make future healthcar

If a person's age is over 105 years, they're somewhere around 99% likely to die within the next 5 years.

I advise that you never start a life insurance business! If someone has lived to 105, not only have they managed to avoid infant mortality (which accounts for many deaths and pulls average life expectancy down dramatically), but they've shown a remarkable ability to stay alive, ie. they're exactly the people whose deaths you *don't* want to bet on! Unless they already have a life-threatening condition, in which case you're cheating;)

I don't know if I would trust a site that does not know how to add simple numbers. They list the percentage chance of dying before 110 and the chance of living past 110, and the two percentages add to 100%. So that means there is no chance of dying during the 110th year. This same thing happens for each age of 106, 107, 108, 109, and 110, so if you can't die during each of those years, I guess you would be expected to live forever.

It's also the story with what I call the "RIAA quote", even though it was aimed at insurance companies:

There has grown up in the minds of certain groups in this country the notion that because a man or a corporation has made a profit out of the public for a number of years , the government and the courts are charged with the duty of guaranteeing such profit in the future, even in the face of changing circumstances and contrary public interest. This strange doctrine is not supported by statute nor common law. Neither individuals nor corporations have any right to come into court and ask that the clock of history be stopped,or turned back, for their private benefit.

The story actually brought to mind a set of short stories I read recently: Machine of Death [amazon.com]

Inspired by a Dinosaur Comics strip, the short stories all share one element: They have a machine that someone (often many people) in the stories use that tells them how they will die. Not when, but how. And not exactly how either. "Stroke" can mean that you are in an airplane crash due to the pilot having a stroke. "Old age" can mean you get run over by an old guy driving a car. However, people in these storie

First, correlation will not tell you causes. Second, correlation does not necessary make individual outcome predictions possible.

For example, out of population that have bad scores on this test mortality may be 19 times higher, but for any given individual it does not necessary means they are going to die in 5 years, or event that they are significantly more likely to die in 5 years.

And we've known most of this for years (the data that is). Albumin is a commonly screened protein - the others not so much. It's long been known that people with very low albumin levels are very sick. Very sick people die soon.

This perhaps gives one a bit more quantification of the phenomena, but it's hardly a surprise.

" or event that they are significantly more likely to die in 5 years."Yes, it does. That's specifically what this is about.Of course, this is just the first paper, and it's the second paper that's the most important.

Oh the classical correlation != causation meme! Read the f***ing paper first and understand the arguments!

You should understand WHICH 4 biomarkers they are testing: VLDL, Albumin, Citrate, and Alpha-1 acid glycoprotein. If these four are high, chances are the metabolism behind these four indicators has been wrong for DECADES and is hardly reversible. It makes sense, therefore, to predict 5-y mortality rate with these 4 biomarkers. Sure the prediction isn't perfect, but boy are they good indicators of someon

When I read "predicts death within five years," I inferred a "to," that is, I expected that the study predicted when a person would die to within a margin of error of five years (death clock), which would be a much bigger deal than what they actually did.

Death is a quite rare thing; ignoring age and other factors, the probability of someone to die within five years is less than 5%. Even when you belong to the top 20% in terms of risk, the probability of death is just 15%, so you're much more likely to be alive than dead after this time. And for what it's worth, the biomarkers are strongly correlated with other factors like "does this person have cancer?", so that in the end the authors say that their new model is just 4% better than previously used models.

Insurers, on the other hand, will want to use these tests and DENY to offer insurance, unless the premium goes up 20 times.

This could easily destroy the life insurance industry as it is today.

Insurance companies already know about this. That is why they measure your HDL cholesterol and total cholesterol when you have a physical. Subtracting the HDL from the total is a lot cheaper than a full lipid profile and gives the same basic information.

Of the top 10 causes of death in the world, according to the WHO, ischemic heart disease and stroke kill more people than the other 8 combined. Doctors already knew that bad cholesterol (ldl/vldl) and inflamation were the leading cause of both of those and have known for decades. The study doesn't show anything that wasn't already known and just adds sensationalism, probably to get increased funding.

The study doesn't "predict death within 5 years" it doesn't even predict death for those with the biomarkers. All it says is people who had higher levels of the biomarkers exhibited a greater risk of dying within 5 years than those with lower levels; according the TFA the study didn't even claim a causal relationship between the markers and a cause of death. Of course, a headline that reads "Study should some people have a higher risk of dying in 5 years than others..." wouldn't be as catchy.

Honestly, after the p-value article, why is this crap still being published? p value was said to mean its worth a second look, but NOT imply anything else

Second, notice its not in PLOS one. Wonder why? Oh right, they require all data to be public, so you can't "use a model" that just happens to make the results you were looking for.

Lastly, percentages e.g. 19 times more likely! See http://xkcd.com/1252/ [xkcd.com] Without the baseline, this 19 times more likely is utterly useless. If their "average case" had a 0.000000000001% chance of death, 19 times that would be 0.000000000019% Thats still pretty low. It reeks of numbers manipulation in an attempt for publicity and funding. If the baseline was something reasonably high, like say 1%, and it jumped to 19%, sure that's quite significant! However, were that the case, it would be far more exciting to say that, than simply 19 times, and they would have done so. My guess is my examples are hyperbole, and the actual is probably closer to 0.1 with those markers, their modeling, number fudging, etc, 1.9%. Still not an accurate predictor of mortality, and basically useless.

Fortunately there's a paper linked to in the summary that answers your concerns.

The 5-y mortality for persons with a biomarker score within the highest quintile was 19 times higher than for those in the lowest quintile (288 versus 15 deaths during 5 y, corresponding to 15.3% versus 0.8%). Individuals within the highest quintile were further differentiated in terms of their short-term probability of dying according to their biomarker score percentiles: 23% of the individuals with a biomarker score within the

It's already pretty crazy the number of blood and urine samples insurance companies collect before they issue you insurance. There is no way they will pass up on incorporating this technology into their tests.

- Why? Yes! Because that website said you were going to die at 3pm, didn't it?- Did it? I can't remember.- How could you forget? It clearly stated that you were going to die, today. At precisely 3:00. Unless it was tomorrow. But no, it's today, at 3:00.

Why would correlation!=causation get anything but -1 pedantic ass mods?

People keep repeating that so much on this board that it is negatively affecting their ability to critically think. When dealing with statistics, sometimes cause isn't important, just predicting an outcome with a high degree of certainty.

Just shut your mouth, and think about the conversation at hand differently.

These 4 markers are wildly disjoint. Clearly not one cause involved here. The causes of them individually are pretty well kno

I'm curious how these people were classified as 'apparently healthy'. It sounds like these biomarkers were all associated with various health conditions. Did these people have undiagnosed health problems that would have been discovered with a general checkup or did this indicate the presence of problems that would have been otherwise undetected?